Andrew Perron, MD, FACEP

SAN DIEGO—The parlance of concussions is sports medicine, as that is the specialty that has done the most research. Picture the parents of a young athlete—a star athlete in their parent’s eyes—asking you about a head injury that just took place.
“Do they have a concussion?” “How long will it last?” “When can they play again?”
Now, take the advice of emergency physician Andrew Perron, MD, FACEP, and be honest with them.

“We have to set some ground rules,” said Dr. Perron, residency program director at the Maine Medical Center in Portland in his ACEP18 Monday session, “Concussion Update 2018: What We Know, What We Think We Know, and What We Don’t Know.” “There is a lot more unknown about concussion than there is known, and that frustrates people. What we have to accept…is that there is just a lot of concussion stuff we don’t know.”
That’s not to say Dr. Perron’s annual presentation lacked clinical pearls. The first misconception he seeks to correct is that a concussion is a one-time event, or as some say, “just a bop on the head.” It’s not. It’s a process.

“Concussions scramble the brain in a way that we don’t really understand,” Dr. Perron said, adding that “the process goes on from the ‘bop’ and can go on for hours, days, or weeks.”

Dr. Perron adds emergency physicians should work to be current on changing literature. Take the subject of cognitive rest. As recently as five years ago, conventional wisdom suggested patients should avoid cognitive activities to let the brain repair itself. More recently, new studies suggest the brain may be better serviced with post-trauma exertion, similar to other body parts.

“We knew for sure that if you had a brain injury, the only thing we have to offer is rest the brain,” Dr. Perron said. “Over the past few years, [our understanding has] really changed…maybe the brain is more like the rest of the body and not some special unique organ that can’t be touched once it has an injury.”

Dr. Perron said some parents and patients are more concerned with concussions because of headlines about chronic traumatic encephalopathy (CTE) and its prevalence in the NFL. His advice when talking to worried people is, again, to be honest about what is known and unknown.

“This is a complex problem that we do not fully understand,” He said. “We do not know everything about concussions. We know more than we knew 10 years ago, but there’s a lot more to know.”